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Autogenous aortoiliac/femoral reconstruction from superficial femoral–popliteal veins: Feasibility and durability  G.Patrick Clagett, MD, R.James Valentine,

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Presentation on theme: "Autogenous aortoiliac/femoral reconstruction from superficial femoral–popliteal veins: Feasibility and durability  G.Patrick Clagett, MD, R.James Valentine,"— Presentation transcript:

1 Autogenous aortoiliac/femoral reconstruction from superficial femoral–popliteal veins: Feasibility and durability  G.Patrick Clagett, MD, R.James Valentine, MD, Ryan T. Hagino, MD  Journal of Vascular Surgery  Volume 25, Issue 2, Pages (February 1997) DOI: /S (97) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

2 Fig. 1 Aortoiliac/femoral reconstructions from SFPVs. A, Fourteen patients underwent SFPV aortounilateral bypass with a limb also fashioned from SFPV anastomosed end-to-side. B, Thirteen patients underwent SFPV aortofemoral bypass with a SFPV femoral crossover bypass. C, Three patients underwent SFPV aortoiliac reconstructions. D, Six patients underwent AFB single-limb replacement or iliofemoral bypass with SFPV grafts. E, Five patients had femoral crossover bypass alone performed with SFPV grafts. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

3 Fig. 1 Aortoiliac/femoral reconstructions from SFPVs. A, Fourteen patients underwent SFPV aortounilateral bypass with a limb also fashioned from SFPV anastomosed end-to-side. B, Thirteen patients underwent SFPV aortofemoral bypass with a SFPV femoral crossover bypass. C, Three patients underwent SFPV aortoiliac reconstructions. D, Six patients underwent AFB single-limb replacement or iliofemoral bypass with SFPV grafts. E, Five patients had femoral crossover bypass alone performed with SFPV grafts. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

4 Fig. 1 Aortoiliac/femoral reconstructions from SFPVs. A, Fourteen patients underwent SFPV aortounilateral bypass with a limb also fashioned from SFPV anastomosed end-to-side. B, Thirteen patients underwent SFPV aortofemoral bypass with a SFPV femoral crossover bypass. C, Three patients underwent SFPV aortoiliac reconstructions. D, Six patients underwent AFB single-limb replacement or iliofemoral bypass with SFPV grafts. E, Five patients had femoral crossover bypass alone performed with SFPV grafts. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

5 Fig. 1 Aortoiliac/femoral reconstructions from SFPVs. A, Fourteen patients underwent SFPV aortounilateral bypass with a limb also fashioned from SFPV anastomosed end-to-side. B, Thirteen patients underwent SFPV aortofemoral bypass with a SFPV femoral crossover bypass. C, Three patients underwent SFPV aortoiliac reconstructions. D, Six patients underwent AFB single-limb replacement or iliofemoral bypass with SFPV grafts. E, Five patients had femoral crossover bypass alone performed with SFPV grafts. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

6 Fig. 1 Aortoiliac/femoral reconstructions from SFPVs. A, Fourteen patients underwent SFPV aortounilateral bypass with a limb also fashioned from SFPV anastomosed end-to-side. B, Thirteen patients underwent SFPV aortofemoral bypass with a SFPV femoral crossover bypass. C, Three patients underwent SFPV aortoiliac reconstructions. D, Six patients underwent AFB single-limb replacement or iliofemoral bypass with SFPV grafts. E, Five patients had femoral crossover bypass alone performed with SFPV grafts. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

7 Fig. 3 Lateral (A) and posteroanterior (B) angiogram of end-to-end anastomosis illustrated in Fig. 2, A. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

8 Fig. 3 Lateral (A) and posteroanterior (B) angiogram of end-to-end anastomosis illustrated in Fig. 2, A. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

9 Fig. 2 Proximal aortic anastomoses. A, Most common anastomosis (90% of cases) was a simple end-to-end anastomosis of proximal, large end of SFPV graft to debrided aorta. Angiographic appearance of this anastomosis is shown in Fig. 3. B, In cases where the aorta was dilated and there was a large difference between aorta and SFPV graft, the aortic diameter was narrowed with mattress sutures as shown. C, In a single case where the pararenal aorta was frankly aneurysmal, distal portion of aneurysm was partitioned with mattress sutures into two tubes to which the SFPV grafts were anastomosed in an end-to-end fashion. Angiographic appearance of this anastomosis is shown in Fig. 4. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

10 Fig. 4 Posteroanterior (A) and lateral (B) angiogram of anastomosis illustrated in Fig. 2, C. At time of aortoiliac/femoral reconstruction, the suprarenal aortic aneurysm was 5 cm in diameter. Over the course of 18 months, aneurysm increased to 7.5 cm in diameter and patient underwent successful repair with placement of a Dacron bifurcated prosthesis with each limb anastomosed end-to-end to SFPV grafts. Left renal artery reimplantation was also performed. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

11 Fig. 4 Posteroanterior (A) and lateral (B) angiogram of anastomosis illustrated in Fig. 2, C. At time of aortoiliac/femoral reconstruction, the suprarenal aortic aneurysm was 5 cm in diameter. Over the course of 18 months, aneurysm increased to 7.5 cm in diameter and patient underwent successful repair with placement of a Dacron bifurcated prosthesis with each limb anastomosed end-to-end to SFPV grafts. Left renal artery reimplantation was also performed. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

12 Fig. 5 Cumulative primary and secondary/assisted patency data of aortoiliac/femoral reconstructions from SFPVs. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

13 Fig. 6 Cumulative proportion of patients without amputation during follow-up. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

14 Fig. 7 Cumulative survival rate of patients who underwent aortoiliac/femoral reconstruction from SFPVs. Journal of Vascular Surgery  , DOI: ( /S (97) ) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

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